The hormone DHEA (dehydroepiandrosterone) is produced by the adrenal glands, which sit on top the kidneys. DHEA is converted by the body into testosterone and estrogen. DHEA may also have other functions but scientists aren't sure what they might be. The body's production of DHEA is highest between the ages of 20 to 30 years and then gradually declines, reaching its lowest level in the elderly. Researchers have found that cells of the immune system, such as CD4+ and CD8+ cells, send signals to the adrenal glands, perhaps triggering their production of DHEA. When T-cell activity is suppressed by the use of drugs such as transplant drugs cyclosporin or tacrolimus, DHEA production falls. In people with HIV infection, HIV-infected cells could also play a role in reducing the production of DHEA.
In the late 1980s and early 1990s several research teams found that DHEA levels were generally lower in HIV positive people compared to HIV negative people of the same age. As well, two research teams found that DHEA levels in HIV positive people decreased over time, reaching their lowest level shortly before the onset of AIDS. Indeed, a group of researchers found that symptom-free HIV positive people with relatively low levels of DHEA were likely to develop AIDS faster than other HIV positive people with higher levels of DHEA.
A simple interpretation of these findings might suggest that DHEA supplementation could play a role in delaying the onset of AIDS. Unfortunately the situation may be more complex than it appears. In times of serious illness, the body may produce larger amounts of hormones such as cortisol (and other glucocortiocoids) than body-building hormones such as DHEA and testosterone. This switch in hormone production occurs because cortisol has anti-inflammatory activity that can help the body cope with the effects of infections, at least temporarily. In HIV infection, a possible role for DHEA might be to balance the excess levels of cortisol, but this theory has yet to be tested. Other potential uses for DHEA in PHAs are as follows:
In this issue of TreatmentUpdate, there are several reports on DHEA, including the impact of HIV infection on production of this hormone, the effect of highly active antiretroviral therapy (HAART) on DHEA levels, as well as the testing of DHEA in people with depression. There is also a warning about possible side effects that can accompany the use of DHEA.
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Copyright © 2001 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
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